Healthcare Provider Details

I. General information

NPI: 1891881033
Provider Name (Legal Business Name): JOY ARMILLAY ED.D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/05/2006
Last Update Date: 12/21/2022
Certification Date: 12/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

340 MONTAGE MOUNTAIN RD
MOOSIC PA
18507-1707
US

IV. Provider business mailing address

PO BOX 1761
KINGSTON PA
18704-0761
US

V. Phone/Fax

Practice location:
  • Phone: 570-208-7755
  • Fax: 570-287-3026
Mailing address:
  • Phone: 570-288-8881
  • Fax: 570-288-8065

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberDN001376
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: